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Effects of Aquatic-Based vs Land-Based Closed Kinetic Chain Exercises on Pain, Functional Performance, Knee
Mahshid Mohammadi1, Farzaneh Gandomi1, Parviz Soufivand2
1Department of Sports Injuries and Corrective Exercises, Faculty of Sport Sciences Razi University Kermanshah Iran.
Background And Aims:
Knee osteoarthritis (KOA) is a progressive degenerative disease causing pain, muscle weakness, and functional decline, particularly in postmenopausal women. While closed kinetic chain (CKC) exercises are effective for rehabilitation, the comparative efficacy of aquatic- versus land-based environments for these exercises remains poorly understood. This study compared the effects of aquatic- and land-based CKC exercises on pain, functional performance, knee proprioception, muscle strength, and kinesiophobia in women aged 40-70 years with KOA.
Methods:
Thirty women aged 40-70 years with knee osteoarthritis were randomly assigned to an aquatic CKC exercise group (n = 15) or a land‑based CKC exercise group (n = 15). Twenty-nine participants completed the 8-week intervention and were included in the final analysis. Both groups performed CKC exercises three times per week for 8 weeks. Primary outcomes were pain (visual analog scale) and functional performance (Western Ontario and McMaster Universities Osteoarthritis Index, Timed Up and Go, stair test, and 40‑meter walk). Secondary outcomes included self‑reported knee instability, kinesiophobia (Tampa Scale of Kinesiophobia), knee proprioception (Inclinometer), and isometric muscle strength assessed with a handheld dynamometer.
Results:
Both groups showed significant within-group improvements in all measured variables (p < 0.05; aquatic d = 0.39 to 3.40; land d = 0.54 to 4.01). However, after adjusting for baseline values (ANCOVA), no significant between-group differences were found in primary or secondary outcomes, except for the 40-meter walk test, where the land-based group showed significantly greater improvement (p = 0.03, η p 2 =0.15).
Conclusion:
Both aquatic- and land-based CKC exercises are equally effective in improving pain, functional capacity, and muscle strength in women with KOA. Clinicians can prescribe either environment based on patient preference, accessibility, and tolerance to weight-bearing, as both yield comparable clinical benefits.